Thank you for your interest in a Graduate Nurse position with St. Cloud Hospital. The application process includes the following:

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1 Dear Graduate Nurse Applicant: Thank you for your interest in a Graduate Nurse position with St. Cloud Hospital. The application process includes the following: 1. Complete the online application for the Graduate Nurse Residency Program-St. Cloud Hospital position at 2. Print and complete the following forms: a) Graduate Nurse Application b) Graduate Nurse Instructor Reference Form Please obtain two references from Nursing instructors c) Release of Employment Information Form Please obtain one work/volunteer reference 3. Provide a copy of your most recent school transcript (does not have to be an official copy). Your prompt attention to completion of these steps is greatly appreciated. Note that your signature is required on the reference forms. Please return all completed documents at once, to: St. Cloud Hospital Human Resources (New Grad RN Program) 1406 Sixth Avenue North St Cloud, MN Or Fax to: Or scan and to: hradmin@centracare.com Thank you for your time and effort in completing the steps necessary for consideration in our Graduate Nurse Residency program. If you are selected for an interview, one of our human resources staff will contact you via telephone or . Sincerely, St. Cloud Hospital Human Resources/Employment Department

2 GRADUATE NURSE APPLICATION Name: Phone # Alternate phone number: Nursing School Attended: Date: List up to 4 areas of interest in order of preference (1-4): Behavioral Health/Mental Health Oncology/Cancer Program Center for Surgical Care Bone & Joint Emergency Trauma Outpatient Services Family Birthing Unit Pediatrics/Neonatal Intensive Care Hospital House Float Pool Rehabilitation Intensive Care Surgery/Operating Room/PACU Kidney Dialysis Surgical Medical Telemetry/Cardiac Care Unit Neuroscience/Spine Home Care/Hospice Other, please specify: What does Professional Nursing mean to you? (OVER)

3 Graduate Nurse Application Page 2 I have requested letters of recommendation from the following nursing instructors: 1. Name Title Address 2. Name Title Address I have requested a letter of recommendation from my previous work place/experience: 1. Name Title Address PLEASE ATTACH A COPY OF YOUR MOST RECENT SCHOOL TRANSCRIPT. (Does not need to be an official copy) Sixth Avenue North, St. Cloud, Minnesota , Fax , Ph St. Cloud Hospital operates under the auspices of the local Catholic church of St. Cloud

4 GRADUATE NURSE INSTRUCTOR REFERENCE *This section to be completed by applicant* Name (please print): School: I have applied to the Graduate Nurse Program at the Saint Cloud Hospital. I request and authorize you to release the information requested below. Signature of Applicant Please check all items that apply to the above applicant. Clinical/Technical Skills Interpersonal Skills Attendance/Dependability Personal Appearance Miscellaneous Date *This section to be completed by evaluator* Easily applies theory to clinical practice Demonstrates confidence in clinical practice Recognizes limitations and seeks assistance Has difficulty applying theory to practice Lacks confidence in clinical practice Not observed in the clinical setting Pleasant, courteous, and respectful of others Utilizes effective communication techniques Shows concern and interest in others Limited ability to communicate effectively Passive/excessively quiet Rarely absent Punctual Meets deadlines Frequently late Frequently absent Unreliable Can be relied upon to follow through or finish the job Good time management skills and organizational skills Consistently neat and well groomed Occasional inappropriate attire and grooming Shows initiative Enthusiastic Flexible Appropriate response to stressful situations Lacks interest or motivation to complete assignments Needs reminders to stay on task or meet expectations As an overall evaluation, considering their peer students, how would you rate this applicant? Upper Third Middle Third Lower Third Comments: Instructor s Name Phone Number Date

5 RELEASE OF EMPLOYMENT INFORMATION AUTHORIZATION & REFERENCE FORM Name: If employed under another name please list here: Social SecurityNumber: I hereby authorize Saint Cloud Hospital to contact the employers, schools and references, which I have provided. I give my permission for you to release any information Saint Cloud Hospital deems necessary for the purpose of evaluating me for possible employment. I hereby release such employers, schools and references from any and all liability for the furnishing of such information. Date: Signature: Please complete the following evaluation of the person requesting this reference: Evaluation Above Average Average Below Average Responsibility Quality of Work Dependability Job Performance Attendance Knowledge of Technical Skills Patient/Co-worker relations Additional comments: Evaluation information from: Personal knowledge File material: Person furnishing information: Title: Telephone# Employer:

6 GRADUATE NURSE INSTRUCTOR REFERENCE *This section to be completed by applicant* Name (please print): School: I have applied to the Graduate Nurse Program at the Saint Cloud Hospital. I request and authorize you to release the information requested below. Signature of Applicant Please check all items that apply to the above applicant. Clinical/Technical Skills Interpersonal Skills Attendance/Dependability Personal Appearance Miscellaneous Date *This section to be completed by evaluator* Easily applies theory to clinical practice Demonstrates confidence in clinical practice Recognizes limitations and seeks assistance Has difficulty applying theory to practice Lacks confidence in clinical practice Not observed in the clinical setting Pleasant, courteous, and respectful of others Utilizes effective communication techniques Shows concern and interest in others Limited ability to communicate effectively Passive/excessively quiet Rarely absent Punctual Meets deadlines Frequently late Frequently absent Unreliable Can be relied upon to follow through or finish the job Good time management skills and organizational skills Consistently neat and well groomed Occasional inappropriate attire and grooming Shows initiative Enthusiastic Flexible Appropriate response to stressful situations Lacks interest or motivation to complete assignments Needs reminders to stay on task or meet expectations As an overall evaluation, considering their peer students, how would you rate this applicant? Upper Third Middle Third Lower Third Comments: Instructor s Name Phone Number Date